Agarwal Anil, Sinha P K, Tandon Manish, Dhiraaj Sanjay, Singh Uttam
*Department of Anesthesia and ‡Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; and †Sree Chitra Tirunal Institute for Medical Sciences &Technology, Trivandrum, India.
Anesth Analg. 2005 Oct;101(4):1230-1232. doi: 10.1213/01.ane.0000167270.15047.49.
Pain associated with venous cannula is a distressing symptom. We evaluated the efficacy of the Valsalva maneuver on pain associated with venous cannulation. Seventy-five adults, ASA physical status I and II, either sex, undergoing elective surgery, were included in this study. Patients were randomized into 3 groups of 25 each. Group I (C): control; Group II (V): blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20 s; Group III (B): pressed a rubber ball. Twenty seconds later, peripheral venous cannulation was performed. Venous cannulation pain was graded using a 4-point scale: 0-3, where 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain, and visual analog scale of 0-10, where 0 = no pain and 10 = worst imaginable pain. A significant reduction in the incidence of pain was observed in the Valsalva group: 18 of 25 (72%) patients, whereas 25 of 25 (100%) experienced pain in the other two groups (P < 0.001). A significant reduction in the severity of pain, number of patients in whom one needed to make the vein prominent before cannulation, and the time taken for the same were observed in the Valsalva group (P < 0.001).
Venous cannulation is a necessary step for safe anesthesia administration; however, the pain associated with it is sometimes very distressing. We observed that the Valsalva maneuver performed at the time of venous cannulation greatly decreases this pain.
与静脉套管相关的疼痛是一种令人痛苦的症状。我们评估了瓦尔萨尔瓦动作对静脉穿刺相关疼痛的疗效。本研究纳入了75例美国麻醉医师协会（ASA）身体状况为I级和II级、性别不限、接受择期手术的成年人。患者被随机分为3组，每组25人。第一组（C）：对照组；第二组（V）：向血压计管道吹气并将汞柱升至30 mmHg，持续20秒；第三组（B）：按压橡皮球。20秒后进行外周静脉穿刺。静脉穿刺疼痛采用4级评分：0 - 3级，其中0 = 无疼痛，1 = 轻度疼痛，2 = 中度疼痛，3 = 重度疼痛，以及0 - 10的视觉模拟评分，其中0 = 无疼痛，10 = 难以想象的剧痛。观察到瓦尔萨尔瓦组的疼痛发生率显著降低：25例患者中有18例（72%），而其他两组的25例患者均经历了疼痛（P < 0.001）。瓦尔萨尔瓦组在疼痛严重程度、穿刺前需要使静脉突出的患者数量以及所需时间方面均有显著降低（P < 0.001）。
静脉穿刺是安全实施麻醉的必要步骤；然而，与之相关的疼痛有时非常令人痛苦。我们观察到在静脉穿刺时进行瓦尔萨尔瓦动作可大大减轻这种疼痛。
